Provider Demographics
NPI:1093418543
Name:WANG AND JEAN DMD INC
Entity Type:Organization
Organization Name:WANG AND JEAN DMD INC
Other - Org Name:WANG AND JEAN DMD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARNG SHING
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-551-4737
Mailing Address - Street 1:4200 TRABUCO RD STE 130
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3622
Mailing Address - Country:US
Mailing Address - Phone:949-551-4737
Mailing Address - Fax:949-551-0180
Practice Address - Street 1:219 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2802
Practice Address - Country:US
Practice Address - Phone:714-667-0161
Practice Address - Fax:714-667-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty